Previous head or neck surgeries c. Previous head or neck radiation 3. Dentition and oral cavity a. Note missing, chipped, or loose teeth b.
May need to remove partials for procedure c. Is uvula easily visualized when patient protrudes tongue? American Society of Anesthesiologists Classification Class I Class I includes patients with no organic, physiologic, biochemical, or psychiatric disturbances. The pathologic process to be treated is localized and does not entail a systemic disease.
Class II Class II includes patients with mild systemic disease caused by either the condition to be treated or by other pathophysiologic processes i. No functional limitations. Conditions include profound shock, massive pulmonary embolism, ruptured blood vessels, and cerebral trauma with increasing intra- cranial pressure. In general, for stable patients without a clinical suspicion of changing laboratory parameters i. Informed Consent. Informed consent is an extremely important part of the procedure and must be obtained for all patients before administration of conscious sedation.
Then, the physician discusses the risks of conscious sedation, catheterization, and coronary intervention in appropriate detail. Providing informed consent takes great commu- nication and interpersonal skills, and it is an important part of the procedure.
Every patient deserves to hear the common potential complications of diagnostic cardiac catheterization Table ; these complications are discussed in greater detail in Chapter 3. The risks should not be glossed over or minimized. Patient dissatisfaction and potential lawsuits often arise from unexpected and improperly addressed minor complications.
For example, a patient with diabe- tes with a serum creatinine level of 3. Risks of Cardiac Catheterization. Finally, a realistic and frank description of the risks in- volved is important, but it must be tailored to the patient. Some patients require a detailed and careful explanation of each potential risk; others need more in the way of reassurance when each risk is explained, sparing them graphic details. Planning the Appropriate Procedure. Based on the precatheterization evaluation, the physician should determine the site of vascular access and plan the exact procedure to be performed.
It should be determined whether a right heart catheterization is indicated. In general, any patient with a heart failure syndrome, unexplained dyspnea or edema, congeni- tal heart disease, pericardial disease, or valvular heart disease, and any patient under evalua- tion for a heart, lung, or liver transplantation may require a right heart catheterization. Simi- larly, patients with unusual chest pain syndromes may need a right heart catheterization to exclude pulmonary hypertension.
Patients undergoing catheterization primarily for the evaluation of recent acute myocardial infarction, stable or unstable angina, or chest pain syndromes without heart failure, hypotension, edema, or suspicion of a mechanical compli- cation generally do not require right heart catheterization.
The location of vascular access should be decided. Most operators in the United States use the right or left femoral artery for arterial access. The presence of an arterial bruit in a patient with peripheral vascular disease does not exclude that artery as a site as long as a femoral pulse is present.
In general, the presence of previous arterial bypass surgery femoral-popliteal bypass or aortobifemoral bypass does not exclude those locations as a possible access site but should be avoided if possible, particularly if surgery has been re- cent.
Brachial artery access is reserved for patients with extensive vascular disease and no arterial pulses in the femoral region, and possibly patients who have had bilateral femoral vascular surgery. Radial artery access is becoming increasingly popular and can be considered in patients with peripheral vascular disease but may also be used routinely as an alternative to femoral access.
A more detailed discussion regarding the different iodinated contrast agents is presented in Chapter Most diagnostic catheterization laboratories use nonionic agents. In patients with renal failure, use of a biplane laboratory, if available, may help reduce contrast use and decrease the likelihood of contrast-induced nephropathy.
It should be assumed that all patients who undergo left heart catheterization also undergo left ventriculography. Important exceptions include patients with renal failure in whom it is desirable to limit contrast volume, patients with decompensated heart failure and abnormal hemodynamics i. Most patients who undergo left heart catheterization will undergo coronary angiography.
Some rare circum- stances include young patients without coronary risk factors referred for evaluation of con- genital or valvular heart disease. Aortography of the aortic root and thoracic aorta may be performed in patients with aortic regurgitation or a thoracic aortic aneurysm. Abdominal aortography is often performed as a screening test for suspected renal artery stenosis at the time of cardiac catheterization in pa- tients with uncontrolled blood pressures refractory to multiple antihypertensive agents or in other situations in which renal artery stenosis is suspected.
Selective renal angiography and intervention and abdominal aortography, and lower extremity runoff procedures for periph- eral vascular disease are not usually combined with a diagnostic cardiac procedure except in special circumstances because of the concern about excessive contrast exposure and the risk of multiple procedures at one sitting. Right ventricular biopsies are performed primarily in patients who have had cardiac trans- plantation. Endomyocardial biopsies in patients without transplantation carry a greater risk for perforation.
These are occasionally performed during the diagnostic evaluation of patients with heart failure. Patients with coronary disease who require bypass surgery found to have a subclavian bruit or a reduction in arterial blood pressure in the left arm relative to the right arm should undergo subclavian angiography to determine the presence of disease in the subclavian artery that might alter the use of the left internal mammary for bypass surgery.
In addition, internal mammary angiography should be considered in patients who require repeat coronary bypass surgery or in patients who have had prior thoracotomy or chest wall irradiation to be sure there was no damage to the left internal mammary. During diagnostic catheterization, trans-septal left heart catheterization is required in pa- tients with a mechanical aortic prosthesis in whom it is necessary to measure left heart pres- sures e.
Other diagnostic indications for trans-septal catheterization include the need to precisely determine left atrial pressure in a patient with suspected mitral stenosis or the desire to avoid crossing the aortic valve retrograde in patients with severe aortic stenosis. Trans-septal pro- cedures are used extensively to perform many electrophysiologic procedures, mitral balloon valvuloplasty and new interventional procedures such as closure of atrial septal defect and patent foramen ovale, percutaneous mitral valve repair, insertion of a percutaneous left ven- tricular assist device, and delivery of left atrial appendage exclusion devices.
Preprocedural Orders. Commonly used physician orders before routine cardiac cathe- terization are listed in Table In addition to these, most physicians recommend holding all oral hypoglycemic agents and giving a half dose of long-acting NPH insulin on the morning of the procedure; patients with an insulin pump should be kept at the prescribed basal rate throughout the procedure and their procedure planned early in the day to avoid a prolonged fasting state.
Preprocedural Orders 1. No solid food after midnight the night before the procedure 2. May have clear liquids until the morning of procedure and then nothing by mouth except for medications 3. If patient is to undergo an afternoon procedure, then a clear liquid breakfast is acceptable with nothing by mouth after that except for medications 4.
Begin an intravenous infusion of 0. For patients at risk for contrast-induced nephropathy, initiate renal protection protocol 1 6. For patients with history of contrast allergy: prednisone 60 mg by mouth the night before and the morning of the procedure; diphenhydramine 50 mg by mouth or intravenously just before the procedure 7. Consider an oral sedative just before the procedure benzodiazepine 8.
Instruct the cardiac catheterization laboratory personnel to prepare the vascular access site regularly scheduled diuretics. Intravenous heparin infusions are usually continued until just before the procedure. Warfarin is routinely held at least 48 to 72 hours before procedure with INR checks as noted earlier. For renal trans- plant patients taking cyclosporine or FK Prograf , the morning dose before catheteriza- tion is typically held to minimize vasoconstriction and resumed the following day.
Postprocedural Orders. Postprocedure orders are important to help minimize potential complications. Commonly used orders are listed in Table Management and monitoring of the vascular access site after the procedure is the most important aspect of these orders. Table Postprocedural Orders 1. Temperature on return to unit 4. Before arterial sheath removal: a. Bed rest and nothing by mouth b. Check vital signs blood pressure and heart rate and the affected limb temperature and sensation, distal pulses, and cannulation site for hematoma or bleeding every 15 minutes for 1 hour, then every 30 minutes for 1 hour, then every 1 hour for 2 hours, then every 2 hours until sheaths removed c.
After arterial sheath removal a. For femoral approach: bed rest for 2—4 hours with affected limb straight after sheath removal and dressing applied; the head of bed may be raised 30—60 degrees and may logroll patient side to side, then increase activity as tolerated; at com- pletion of bed rest, obtain orthostatic vital signs before ambulation b.
For patients with arterial closure device: bed rest for 1—2 hours after arterial sheath removal and dressing applied; head of bed may be raised 60 degrees; patient may freely move in bed immediately after procedure as long as there is no bleeding at access site; at completion of bedrest, obtain orthostatic vital signs before ambulation d.
When sheaths removed, check vital signs, distal pulses, access site, cannulated limb temperature, and sensation every 15 minutes for 1 hour, then every 30 minutes for 1 hour, then every 1 hour for 2 hours 6. May place bladder catheter for inability to void while on bed rest; discontinue at completion of bedrest 7. At completion of bed rest, remove adhesive dressing if any and evaluate site for hematoma, bruit, ecchymosis, or rash 8. Medications: analgesics for procedural pain, antacids, medication for nausea, sleeping aids These include patients with severe aortic stenosis or severe aortic regurgitation, severe left main stenosis, coagulopathy or thrombocytopenia, presence of a large access site hematoma, severe hypertension, morbid obesity, or severe peripheral vascular disease.
At least one patient visit after the procedure is important to determine the presence of any periprocedural complications such as dye reactions, subtle neurologic complications, and vascular complications. This visit also provides the patient an opportunity to ask ques- tions regarding his or her procedure.
Activity is typically restricted for 2 days after cardiac catheterization. Reference 1. Catheter Cardiovasc Interv ;— These two steps are often considered trivial, yet they arguably consti- tute the most important parts of the procedure.
Vascular complications remain the most common cause of morbidity from cardiac catheterization, with several of them potentially life-threatening. Most complications are related to improper technique for gaining access or achieving hemostasis. General Considerations in Obtaining Vascular Access. In the United States, the right femoral artery and vein are the most common access sites; the right internal jugular vein is the most common site when right heart catheterization alone is performed.
The operator may seek alternatives to these sites depending on several important patient characteristics. The presence of periph- eral vascular disease, prior vascular surgery, or intervention may prevent access via the usual route and require use of an alternative site.
The risk for bleeding is another important vari- able. Patients at greater risk for bleeding e. Equipment Choices. A variety of needles, guide wires, and sheaths are available for secur- ing arterial or venous access. This has mostly been abandoned by most operators for a one-piece, hollow-core needle without an obturator. Once an artery or vein has been successfully punctured, a guide wire is advanced through the lumen and the needle removed.
Usually, a 0. This may be too large when accessing smaller diameter arteries, necessitating the use of a smaller diameter J loop 1. Sheaths are used to secure ac- cess. Most cardiac catheterizations and interventions use cm-long, 5- to 8-French Fr sheaths. The sheath size refers to the internal lumen of the sheath Table The outer diameter of the sheath i. Many different sheaths are available on the market, with different properties useful to the operator such as hydrophilic coatings to ease passage and braided metal to prevent kinking.
Femoral Arterial Access. Left heart catheterization in the United States is most com- monly performed from the femoral arteries. Nearly all vascular access is achieved using some form of the Seldinger technique, described in by the Swedish radiologist Sven-Ivar Seldinger — The needle is advanced at a to degree angle until arterial blood spurts in a pulsatile fashion from the end of the needle. The original technique used a needle with a solid obturator and intentionally passed the needle through the back wall of the artery, removing the obturator and slowly withdrawing until pulsatile blood returns.
Most operators now try to puncture only the front wall of the artery. Blood should be freely pulsatile; if blood return is bright red but not pulsatile or only weakly pulsatile, the needle tip may be partially subintimal, against the wall or in a small side branch.
The wire should pass freely with absolutely no resistance. The presence of resistance indicates a subintimal location of the needle tip, access of a small side branch instead of the appropriate vessel, or the presence of a stenosis. The wire should never be forced because this may result in subintimal passage and arterial dissection, vessel perforation, or plaque disruption. With the guide wire in place in the distal aorta, the needle is withdrawn while gently ap- plying pressure on the vessel with the left hand to prevent excess bleeding.
The sheath is passed over the wire and inserted fully. Once the sheath is in place, the guide wire is removed. Again, there should be minimal or no resistance when passing the sheath over the guide wire. A small skin nick 2—3 mm facilitates passage of the sheath. The target of the arterial puncture is the common femoral artery. Many major and poten- tially lethal vascular complications are related to punctures either above or below the com- mon femoral artery. The normal anatomy of the femoral vessels and their relations to several important land- marks are shown in Figure The inguinal ligament provides the boundary between the common femoral artery and the external iliac artery.
External landmarks are completely unreliable. The commonly used technique of palpating the pubic symphysis and anterior iliac spine followed by mental visualization of the location of the inguinal ligament is inaccurate. Some operators puncture relative to the inguinal crease, made up of the skin fold between the abdomen and the groin. In the idealized and nonexistent patient with a normal body habitus, the inguinal crease lies 1 to 2 cm below the inguinal ligament.
Based on this observation, puncture at or just below the inguinal crease is a commonly performed practice for accessing the femoral artery. However, the inguinal crease is entirely unreliable and should not form the basis of the puncture location. In very thin patients, the crease may be higher than expected, causing puncture of the external iliac instead of the common femoral artery.
The common femoral artery lies over the medial aspect of the femoral head Fig. Directing the puncture toward the center of the femoral head successfully accesses the common femoral artery in most cases 1. Fluoroscopic guidance must be done properly, however. This is particularly true for obese patients.
With the sheath in place, femoral arteriograms are helpful to determine the precise loca- tion of the puncture and are particularly useful when deciding on the method to achieve hemostasis, particularly in an anticoagulated patient.
The ipsilateral oblique projection 20—30 degrees is used most commonly i. The opposite oblique may be used if this view does not show the entry site or if branches overlap. The location of the inferior epigastric artery should be carefully noted on femoral angiography. This is a crucial landmark because puncture above the most inferior border of the inferior epigastric artery not the site of origin of the branch is associated with retroperitoneal bleed Fig.
Examples of femoral arteriograms showing both optimal punctures and punc- tures above and below the common femoral artery are shown in Videos , , and Special Considerations in Femoral Arterial Access. Several commonly encountered situations add complexity to femoral arterial access. These include the presence of iliac tor- tuosity, peripheral vascular disease, and coagulopathy. When obtaining access in such patients, the operator may encounter resistance during guide wire passage.
Use of a long sheath helps straighten the iliac vessels and facilitate catheter manipulation. An example of severe iliac tortuosity requiring a long sheath is shown in Figure The presence of a bruit or established iliac or femoral stenosis does not neces- sarily exclude a site from consideration for access as long as the pulse is palpable.
In general, the site with the strongest palpable pulse is chosen and care taken when advancing the guide wire. Fluoroscopic guidance ensures that the guide wire advances smoothly.
If a J-tipped guide wire does not easily advance, a hydrophilic wire may prove successful. Hydrophilic wires used in conjunction with the access needle should proceed with great care because careless withdrawal of the wire through the needle may cut or damage the wire.
In general, in the presence of prior vascular surgery or intervention, an alternative access site should be chosen. If unavoidable, the femoral approach is acceptable more than 3 months after place- ment of iliac stents, or aortic stent grafts, or after aortofemoral, or aortoiliac bypass surgery.
In the presence of femoral-femoral bypass or femoral-popliteal bypass, it is probably best to use the brachial or radial approach. Patients with coagulopathy or platelet disorders are at an increased risk for access site bleed- ing and access-related complications. If possible, these disturbances should be corrected be- fore catheterization. This is not always possible either because the procedure is emergent or because the coagulopathy cannot be readily corrected e. For elective procedures, the cutoff values used at the University of Virginia include an inter- national normalized ratio INR less than 1.
When catheterization is necessary in a patient with coagulopathy or platelet disorder, several techniques can be used to reduce vascular complications. Vascular closure devices may prove useful. In addition, the radial artery can be considered as an alternative access site. Prolonged bed rest after sheath removal may prevent bleeding complications. Brachial Artery Access. The brachial artery provides an alternative to the femoral artery for left heart catheterization access the left brachial artery is often chosen over the right bra- chial artery because the preformed coronary catheters engage easier.
The brachial approach is chosen when femoral access is undesired, usually because of peripheral arterial disease. Accessing the brachial artery is similar to the technique described for the femoral artery with a few important differences. Because the brachial artery is smaller in diameter, the punc- ture requires greater care. Careful monitoring of the distal pulse should be performed during and after the procedure.
The brachial approach has a greater complication rate than the femoral approach. This is predominantly due to the fact that the brachial artery is smaller and an end-organ artery. Thrombosis of the brachial artery is more common than in the femoral artery and leads to acute, limb-threatening ischemia. Hematoma formation, usually well tolerated in the femoral area, may lead to compartment syndrome and limb ischemia. Median nerve injury is another unique complication of brachial access and is due to the close proximity of the nerve to the artery.
Because of the greater complication rate associated with brachial artery catheterization, radial artery access is the preferred alternative to the femoral artery. Radial Artery Access. In selected patients, the radial artery can be used as an alternative to femoral or brachial access. The technique is not appropriate for all patients. The ulnar and radial arteries join to form the palmar arch, supplying the circulation to the hand.
The examiner then releases compression on the ulnar artery and determines the time it takes to restore the pink color of the hand; a normal response is within 10 seconds. The radial approach is favored by some operators as the primary access site for cardiac catheterization, particularly outside the United States. After administering a small amount of local anesthesia over the radial artery, the operator uses a small needle 21 gauge to puncture the artery.
When arte- rial blood returns, a 0. The wire should pass easily to the brachial artery before advancing the sheath. Hydrophilic-coated sheaths are easier to position and remove than conventional sheaths. Many operators locally administer a combination of drugs to prevent or reverse spasm provoked by instrumentation.
The University of Virginia laboratory uses a cocktail of 1 mg verapamil combined with mcg nitroglycerine in 10 mL heparinized saline. The entire 10 mL is administered as a bolus through the arterial sheath, and up to 10 doses may be used during a case. Others have used a mixture of 5 mg verapamil and mcg nitroglycerine or administer topical nitrates over the site. From the radial approach, the end of the guide wire may preferentially enter the descending aorta. This often frustrating problem may be corrected by instructing the patient to take a deep breath allowing the wire and catheter to more easily enter the ascending aorta.
Selective cannulation of the coronary arteries can be chal- lenging, particularly for operators with more experience from the femoral approach. A different set of catheters is often required, especially for the left coronary artery. With experience, how- ever, the radial approach can be readily mastered and provides a valuable alternative to the traditional femoral access site. Complications of radial artery access are uncommon.
The most frequent adverse event is forearm pain from radial artery spasm. Failure from the radial approach is often due to the presence of a radioulnar also called recurrent radial loop Fig. Aggressive attempts at wire positioning may lead to vessel perforation or dissection, and in the event a guide wire is successfully positioned, catheter advancement and manipulation will likely prove impossible.
Loops may be present at several locations in the radial artery. More rarely, they involve the brachial or subclavian arteries. This may lead to complications such as dissection and in- ability to complete the case from the radial artery; an example of this is shown in Video In some patients, it is not possible to successfully engage one or more of the coronary arteries; this problem substantially decreases with operator experience.
Rare complications include perforation of the radial artery or one of the small branches of the radial artery, hematoma, and possible compartment syndrome, and entrapment of the sheath or catheter caused by intense spasm. Case reports of avulsion of the radial artery and chronic regional pain syndrome have been reported.
Venous Access. Venous access is required to perform a right heart catheterization. The technique for achieving venous access is similar to that used for an artery with the exception that the venous pulse cannot be felt. The operator must rely on anatomic landmarks or adja- cent arterial pulsations to guide the puncture. A hollow-core needle attached to a syringe is used to puncture the vein.
Features a wealth of quick-reference tables, and more than images — making this handbook a must-have reference for physicians and staff members in every cath lab. Includes new content on correction of mitral regurgitation with Mitra ClipTM, enhanced coverage of aortic valve stenosis with TAVR, expansion of biodegradable and drug-eluting stents, enhanced descriptions of lesion assessment, chronic total occlusion intervention, and radial access approach to intervention.
Rinder, M. Kern, S. Khoukaz, S. It takes you through a detailed review of equipment, specific laboratory techniques, and lab safety, as well as the limitations, complications, and medical-surgical implications of cardiac catheterization and angiography findings. The book's portable size make it the preferred pocket reference! Presents clear instructions on what to expect, what to avoid, and how to manage complications.
Features a straightforward, easy-to-understand approach and a pocket-sized format that are ideal for reference by practitioners on the go. Covers all of the newest interventional techniques, including the use of drug-coated stents, carotid stenting, and renal stenting. Presents brand-new coverage of vascular closure devices and radial artery catheterization. Features an increased emphasis on congenital heart disease. Incorporates new material on patient preparation, laboratory setup, and the digital lab.
It covers basic principles, diagnostic strategies for specific diseases, and the newest interventional techniques, giving readers the tools to successfully manage all types of valvular and structural heart disease. It is essential for interventional cardiologists, cardiology fellows, and interventional radiologists who want to quickly increase their knowledge and skills and offer optimal care to their patients.
Expert Consult eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, videos, images, and references from the book on a variety of devices.
Download PDF. The Pocket Guide to Diagnostic Cardiac Catheterization provides general cardiology fellows, nurses, and technicians entering the cardiac catheterization laboratory a practical guide addressing key aspects of left and right heart catheterization, selective coronary angiography, and the utilization of other invasive cardiology procedures for diagnostic purposes.
Also included is a chapter with video clips that highlight the role and technical versatility of the multipurpose catheter in cardiac catheterization—a technique developed, taught, and learned over many generations in the cardiac catheterization laboratories at Emory University.
Cardiac Catheterization and Imaging is an all-encompassing, richly illustrated guide to cardiac catheterisation and catheter-based intervention, from the foetus to the geriatric patient. The book is divided into 72 chapters across twelve sections, covering everything from the history of cardiac catheterisation, patient preparation, imaging modalities available in preparation and during the procedure, and the equipment required.
Beginning with the history and basics of catheterisation, and a section on haemodynamics, subsequent sections cover a range of interventional techniques for heart disease. Further sections bring the text firmly up to date, with recent techniques in valvular aortic disease covered, a chapter on current indications for interventions in adults with congenital heart disease, and the latest equipment available for cardiovascular support.
Each chapter concerning a specific condition follows a regular format; a concise discussion on the disorder, indications, procedural details, precautions, and potential pitfalls. With nearly images and illustrations, spanning pages, Cardiac Catheterization and Imaging is an invaluable, comprehensive resource for cardiologists. Key Points Comprehensive, illustrated guide to cardiac catheterisation from foetus to geriatric patient Covers history, basics, haemodynamics, various interventions and equipment images and illustrations.
The premier reference on cardiac catheterization is now in its thoroughly revised Seventh Edition, reflecting the rapid evolution and growing clinical use of interventional techniques.
The completely revamped interventional section includes new material on treatment of pediatric and adult congenital heart disease, as well as on coronary atherectomy, thrombectomy, distal embolic protection devices, bare metal and drug-eluting stents, and percutaneous valve therapies. Other significantly revised chapters include pulmonary angiography, endomyocardial biopsy, and circulatory assist devices.
This edition's companion DVD features more than digital cases, plus more than 20 animations showing the actions of various invasive and interventional devices.
Updated for its Second Edition, Introductory Guide to Cardiac Catheterization is an easy-to-follow "how-to" guide to diagnostic and therapeutic cardiac catheterization. Numerous illustrations demonstrate the complex procedures now being performed via the catheter.
This edition has a section on complications in each chapter, a new chapter on peripheral angiography, and a new question-and-answer review chapter.
Other highlights include new safety precautions and updates on novel closure devices. This practical handbook is based on an internal working manual developed by staff and fellows at Mount Sinai Heart Cardiovascular Catheterization Laboratory, renowned for its high-volume and low complication complex coronary procedures.
The Practical Handbook of Interventional Cardiology captures the knowledge and methodological know-how from leaders in interventional cardiology, it intends to guide users in a stepwise, methodical and practical approach through various cardiac interventional procedures in order to achieve maximum patient safety and improved outcomes. From patient selection, preoperative work-up, setting up equipment to step-by-step illustrations of various procedural details and troubleshooting, this handbook captures all the details necessary to perform the simplest to the most complex cardiac interventions.
The book is designed for cardiologists and trainees who desire an efficient way to review the steps of various cardiac interventional procedures and a quick, reliable reference for everyday use. Whether you're an experienced practitioner, resident or cardiology fellow, you'll find this an irreplaceable cardiac reference.
The authors offer expert overviews of the theoretical and practical aspects of clinical issues, with increased stress given to hemodynamic data and tracings and interventional procedures. The clear, succinct text is illuminated by summary tables, illustrations and real-life images. Perfectly designed for quick access and easy reference! Cardiovascular Hemodynamics for the Clinician, 2nd Edition, provides a useful, succinct and understandable guide to the practical application of hemodynamics in clinical medicine for all trainees and clinicians in the field.
Concise handbook to help both practicing and prospective clinicians better understand and interpret the hemodynamic data used to make specific diagnoses and monitor ongoing therapy Numerous pressure tracings throughout the book reinforce the text by demonstrating what will be seen in daily practice Topics include coronary artery disease; cardiomyopathies; valvular heart disease; arrhythmias; hemodynamic support devices and pericardial disease New chapters on TAVR, ventricular assist devices, and pulmonic valve disease, expanded coverage of pulmonary hypertension, fractional flow reserve, heart failure with preserved ejection fraction and valvular heart disease Provides a basic overview of circulatory physiology and cardiac function followed by detailed discussion of pathophysiological changes in various disease states.
Manual of Percutaneous Coronary Interventions: A Step by Step Approach is a practical, easy to read reference guide on how to perform percutaneous coronary.
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